The long-term goal of the proposed four year project is to improve the quality of care and therefore the quality of life of nursing home residents in a cost-effective manner. The specific aims are to: 1. Determine if resident outcomes are improved when scientifically-derived protocols are implemented by APNs for the following resident problems: a) incontinence, b) pressure sores, c) depression, and d) disruptive behavior. (Protocol/APN Only Intervention) 2. Determine if resident outcomes using the Protocol/APN-Only Intervention are improved by the inclusion of the APN in the following organizational roles: inservice educator, participant in organization-wide quality assurance activities; and consultant to staff. (Organizational Intervention, Stage 1) 3. Determine if resident outcomes using the Protocol/APN Intervention plus the Organizational Intervention, Stage 1 are improved further by adding the following organizational changes: nursing grand rounds, quality circles, and in-house resource teams with expertise in each of the protocols. (Organizational Intervention, Stage 2) 4. Determine if scientifically-derived protocols used by advanced practice nurses reduce the costs of nursing home care for: a) residents; b) nursing homes, and c) third party payers. 5. Determine if the addition of Organizational Interventions to the Protocol/APN Intervention further reduces the cost of nursing home care for a) residents, b) nursing homes, and c) third party payers. 6. Determine if staff outcomes (job satisfaction, turnover, and perception of the organizational climate) are improved by the Protocol/APN-Only Intervention, the Protocol/APN Intervention plus the Organizational Intervention Stage 1, and the Protocol/APN Intervention plus the Organizational Intervention Stage 2. The quasi-experimental design will randomly assign the two treatments and the control to three nursing homes that are comparable with respect to a number of relevant characteristics. Three cohorts of newly admitted residents at each facility will comprise the sample (N= 108 per facility). Resident outcomes to be measured include length of nursing home stay, use of emergency department, number of hospitalizations and days hospitalized, Presence and stage of pressure sores, presence and frequency of incontinence, mental status, morale, presence and level of depression, presence and extent of disruptive behavior, stress level, and functional status. In addition, data will be obtained on resident and family satisfaction, staff job satisfaction, turnover, absenteeism, and selected fiscal outcomes. Findings from the study will provide information about the efficacy of specific intervention protocols for incontinence, pressure sores, depression, and disruptive behavior in terms of both resident and fiscal outcomes. In addition, comparisons will be made between resident outcomes with and without the implementation of scientifically-derived protocols by an APN and with and without the addition of organizational interventions.